TORONTO - Um ... OK ... it's an embarrassing topic for many people. You know, butts and intestines and bowel movements and all that. But when it comes to saving lives by preventing colon cancer, let's face it, there's no such thing as too much information.
To that end, the Colorectal Cancer Association of Canada, in conjunction with government partners, has been taking a "giant colon" on the road to cities across Ontario to educate people about the disease and to promote the need for screening.
At 12 metres long and 2.5 metres high, the pink worm-like structure allows visitors a walk-through view of the inside of a colon, although this one is made of a plasticized material that keeps its shape thanks to compressed air.
Once inside, visitors see the stalky, mushroom-like growths called polyps attached to the colon's lining and what they may evolve into if not removed -- the dreaded mass of cells that indicates a tumour.
Since January, the exhibit has visited nine Ontario cities, including London, Kingston, Thunder Bay and Toronto. More stops are planned in Ontario, including Peterborough and Ottawa/Renfrew, and it will also travel to Montreal and other locations in Quebec.
"It attracts a lot of attention," says Dr. Linda Rabeneck, medical director of Ontario's colorectal screening program.
And that's the whole point, says the gastroenterologist from Sunnybrook Health Sciences Centre in Toronto, who sees too many patients whose newly diagnosed colorectal cancer has already reached an advanced stage. "We hope that they'll be aware that this is an important cancer."
"One of our messages is you don't think about it, it's your bowels. We don't talk about our bowels or colons or rectum, but this is actually the No. 1 cause of cancer deaths in Canadian men and women that's not related to tobacco."
The Canadian Cancer Society estimates that 22,000 people were diagnosed with colorectal cancer in 2009, and about 9,100 died last year from the disease. Only lung cancer has a higher mortality rate.
"We hope to show them what the colon is, how these cancers grow from the innermost lining of the colon, and get them thinking about it," Rabeneck says. "And get men and women realizing that they need to get screened."
Ontario was the first province to launch a formal colorectal screening program, which began in April 2008. It was followed soon after by Manitoba, and since then all provinces except Newfoundland and Labrador have announced or begun implementing a similar program.
For the average person, without any symptoms or a family history of colorectal cancer, screening should start at age 50 with a test that looks for microscopic evidence of blood in the stool. Two types of tests are used, depending on the province, either a fecal occult blood test (FOBT) or a fecal immunochemical test.
"That's a simple at-home test," explains Rabeneck. "If it's positive, then you need to have a colonoscopy."
For anyone with a family history -- a first-degree relative like a parent or sibling who's been diagnosed with the disease -- the recommendation is to forego fecal blood testing and go straight to colonoscopy, she says.
That test involves having a viewing scope threaded through the rectum and along the length of the colon. Any polyps detected by the physician are snipped off and collected for testing to determine whether they are pre-cancerous or already malignant.
For such high-risk patients, the first colonoscopy should be performed at age 50, or 10 years younger than the age at which their relative was diagnosed, whichever comes first, says Rabeneck. "So if someone had a mom who was diagnosed at 52, then they should have a colonoscopy at 42."
The interval between colonoscopies depends on what's detected, she says. For a person with no family history whose colon is found to be clear, it could be 10 years before another is needed. For the high-risk patient with no sign of cancer or pre-cancerous polyps, the average interval is five years.
"It depends on what they find."
Terry Sullivan, president and CEO of Cancer Care Ontario, says premature death from colorectal cancer can be reduced by an estimated 16 to 30 per cent using just routine FOBT screening.
Since the province-wide screening program was introduced, more than one-third of the target population is having the test, up from a base rate of 12 to 15 per cent, he says. "And when you take FOBT and screening colonoscopy for higher-risk (patients), I think half of the eligible population is now having a procedure in Ontario."
"But we still need to get the rest of the population engaged," Sullivan says, noting that Canada has one of the highest rates of colorectal cancer in the world, along with the United States, the United Kingdom, other northern European countries, Australia and New Zealand.
The higher rates among western countries has been linked to lifestyle factors. Part of the giant colon campaign is to educate visitors about diet -- reducing red meat and saturated fat, eating more fibre and fruits and vegetables -- and getting regular exercise and avoiding smoking.
"But I think the main message here is: 'Get screened,"' says Sullivan. "Screening can reduce the burden of the disease ... Over 60 per cent of colon cancer patients now survive five years or more and that will continue to head north as we screen more and more people in the population."
Barry Stein, president of the Colorectal Cancer Association of Canada (CCAC), says catching the disease at its earliest stages means a much higher chance of cure.
In 1995, Stein was diagnosed at age 41 with advanced colorectal cancer. He'd been having symptoms, but had ignored them. He's the first to admit that was a big mistake -- and it's made him passionate about encouraging others to get screened before any signs of the disease make themselves known.
"The colon cancer had gone to my liver and into my lungs," says the Montreal lawyer, whose treatment included nine surgeries plus bouts of chemotherapy.
"It's hard to believe over a million dollars (in treatment costs), all that stress, all that pain, all that suffering could have been avoided by simply removing a polyp before it became cancerous," says Stein, who's been cancer-free for about the last seven years.
